Nebraska Department of Insurance

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THE NEBRASKA HEALTH INSURANCE INFORMATION, COUNSELING, AND ASSISTANCE (NICA) PROGRAM

MARCH 2001 NICA NEWS

CHANGES

Changes in the Benefits Improvement and Protection Act (BIPA) of 2000 Improvements Act Passed

In December of 2000, the Medicare, Medicaid, and SCHIP (Children's Health Insurance Program) BIPA was signed into law. This law continues to make adjustments to the provisions created by the Balanced Budget Act (1997) and the Balanced Budget Refinement Act (1999). The following is a partial list of some of the changes made to the Medicare program as well as their effective dates.

Pap test and pelvic exams will now be covered once every 24 months. Prior to BIPA, the Pap test and pelvic exam were covered once every 36 months. Beginning in July 2001 of this year, this preventive service will be available once every two years.
Annual screening test for glaucoma. Prior to BIPA, glaucoma tests were covered if they were used to diagnose a condition. Annual screening tests for glaucoma will be covered for people with family history of glaucoma and for those with diabetes. Effective date: 1/1/02.
Expansion of Colonoscopy. Before BIPA, coverage for a colonoscopy was limited to individuals at high risk for colon cancer. Beginning in July of this year, coverage for this preventive service will be expanded to cover average-risk individuals, determined by a doctor.
Elimination of time limits for immuno-suppressive drug therapy. Before BIPA, immunosuppressive drug therapy for transplant patients was limited to 36 months, with a possible eight month extension created by the BBRA. Effective 12/22/00, there will no longer be any time limits on immunosuppressive drug therapy.
Elimination of the 24 month waiting period for Medicare for people with Lou Gehrig's disease. This BIPA provision allows Medicare coverage for individuals on disability due to Amyotrophic Lateral Sclerosis (also known as ALS or Lou Gehrig's Disease) without the customary 24-month waiting period. Effective date: 7/1/01.
One-year continuation of moratorium on therapy caps. The moratorium on caps for physical and occupational therapy will be extended through 2002.
Increase in minimum payment amount to Medicare + Choice organizations.

Compare Dialysis Facilities

The Health Care Financing Administration (HCFA), the federal agency that administers Medicare, has launched Dialysis Facility Compare, a new tool on www.medicare.gov to help Medicare beneficiaries learn about Medicare-certified facilities that offer kidney dialysis to patients with end-stage renal disease.

Information includes the quality of care and survival rates at 3500 dialysis facilities in the U.S., the date the facility was certified by HCFA, and which facilities offer treatments after 5:00 p.m. The web site data was selected with the assistance of experts in the renal community representing health care professionals, patients, and patient advocates.

End-stage renal disease is a common complication of chronic diabetes and hypertension. More than a quarter of a million people in the U.S. receive dialysis treatments.

Dialysis Compare is the latest addition of comparison tools on HCFA's web site. About 800,000 visitors per month visit www.medicare.gov to compare nursing homes and Medicare health plans in their home states and counties, identify providers and programs that offer low-cost or free prescription drugs and compare Medigap policies.

Medicare Coordination of Benefits (COB) and You

The Medicare COB program wants to make sure Medicare pays your claims right the first time, every time. We collect information on your health care coverage and store it in your Medicare record. This record must be updated every time you make a change to your health care coverage. Information comes from these sources:

Your Initial Enrollment Questionnaire (IEQ)
Your doctor and other providers
Your group health plan
Your employer
You

You can help keep your Medicare record up to date. Let your doctor and other providers know about insurance changes so that they can pass them along to Medicare. Medicare will use this information to determine who should pay your claims first. This will speed up and improve the payment process.

Medicare may be your secondary payer. Your record should show whether a group health plan or other insurer should pay before Medicare. Paying claims right the first time prevents mistakes and problems with your health care plans.

If you have general questions about Medicare COB, contact the COB Customer Service Department at 1-800-999-1118 or www.hcfa.gov/medicare/cob on the Internet.

Home Health Carrier
New Cahaba Address:
Medicare Part A Correspondence
400 East Court Ave.
Des Moines, IA 50309-2017
(877) 910-8139

TRICARE for Life to Extend Benefits to Retired Military

In the next year, health care benefits to 1.4 million Medicare-eligible military beneficiaries, spouses and survivors will improve dramatically. TRICARE officials state the full impact on the Defense Department will take months to sort out.

On April 1, 2001, all military beneficiaries eligible for Medicare, whether by age or disability, will gain access to affordable prescription drugs. They will be able to use the military's National Mail Order Pharmacy Program to buy a 90-day supply of a drug at a cost of $8 per prescription.

Those who live near a base pharmacy may continue to use them at no charge. Also, beneficiaries can use the TRICARE retail benefit, which requires a 20% copayment per prescription. Older retirees, their spouses and survivors who live outside a TRICARE network will have two choices: mail order or non-network retail benefit, with a 20% copayment per prescription; or mail order or non-network retail benefit, with a $150 deductible and a 25% copayment per prescription.

On October 1, 2001, the second half of the benefit kicks in, whereby all Medicare eligible retirees and their spouses will be allowed to enroll in TRICARE Prime, the military's managed care plan, or choose to select a civilian provider off base. If an off base provider is selected, Medicare will pay first and TRICARE Standard (once known as CHAMPUS) will pick up whatever costs, fees, or deductibles Medicare doesn't cover.

The cost of enrollment in either of these plans is limited to the cost of Medicare Part B enrollment, with no additional fees. For further information on TRICARE, call 800-669-8387.

Companies Discontinuing Medicare Supplement Coverage

Academy Life Insurance Company is discontinuing marketing and issuing Medicare Supplement insurance in Nebraska.

Pioneer Life Insurance Company is discontinuing marketing Medicare Supplement insurance in Nebraska.

GE Life and Annuity Assurance Company will discontinue marketing Medicare Supplement Plans B and H in Nebraska. They will continue to market other plans in our state.